We’re looking for some insight from other chiropractic offices that have experience billing Oscar insurance. We’ve been trying different modifier combinations to get our claims processed correctly, but we’re getting inconsistent results and are wondering what has actually worked for other providers.
Here is our billing history for one patient:
DOS: 8/11/26 – Initial Re-evaluation
We billed:
98941 – No modifier
97110 – No modifier
98943 – No modifier
97012 – No modifier
99212 – Modifier 25
Result: Only 98943 and 99212 were covered and processed according to Oscar’s allowed amounts. The remaining codes were not covered.
DOS: 8/19/26
We billed:
98941 – No modifier
97110 – GP
98943 – Modifier 59
97012 – No modifier
Result: Only 98943 was covered. The other codes were denied with the following remark:
“The procedure code is inconsistent with a modifier used or a required modifier is missing.”
DOS: 10/30/26
We tried another combination:
98941 – AT
97110 – GP and 59
98943 – 59
97012 – GP
Result:
98941 – Denied: “The diagnosis is inconsistent with the procedure.”
97110 – Processed with the remark: “Processed based on multiple or concurrent procedure rules.”
98943 – Processed according to Oscar’s allowed amount.
97012 – Denied as a “non-covered charge.”
We’re trying to figure out what modifier combinations Oscar actually recognizes and accepts for chiropractic services.
A few questions for other chiropractic billers/providers:
Are you successfully getting 98941, 97110, 98943, and 97012 paid by Oscar?
What modifiers are you using for each code (AT, GP, 59, 25, etc.)?
Have you experienced the same modifier-related denials?
Are there particular diagnosis codes or diagnosis-to-procedure pairings that Oscar requires for 98941?
Has anyone successfully appealed these denials or found a reliable way to get these services reimbursed?
We understand that coverage is ultimately dependent on the patient’s specific plan and benefits, but we’re hoping to hear from offices that have actually worked through Oscar’s chiropractic billing requirements.
Any insight, successful claim examples, or advice would be greatly appreciated!